A pelvic mass describes an abnormal growth or enlargement situated within the lower abdomen or pelvic region. This area contains reproductive organs (uterus, ovaries, fallopian tubes), intestines, and the bladder. The term “mass” indicates an abnormal area identified during an exam or imaging. A pelvic mass can be benign (non-cancerous) or malignant (cancerous), but its presence does not automatically equate to a serious diagnosis.
Recognizing the Symptoms
Not all pelvic masses produce noticeable symptoms; some are found incidentally during routine examinations or unrelated imaging. When symptoms occur, they are usually related to the mass’s size and location, especially if it presses on surrounding organs like the bladder or bowel.
A common complaint is persistent or intermittent pelvic pain, manifesting as a dull ache or sharp discomfort. Many individuals experience abdominal fullness, pressure, or bloating, which may lead to a decreased appetite.
Changes in normal bodily functions are frequently reported, including an increased need to urinate or difficulty fully emptying the bladder. Bowel habits may change, sometimes resulting in constipation. Abnormal vaginal bleeding, such as bleeding between menstrual cycles or after menopause, can also signal a pelvic mass.
Diverse Origins of Pelvic Masses
The cause of a pelvic mass is categorized based on whether the growth originates from gynecologic organs or non-gynecologic structures like the bowel or urinary tract. The likelihood of a mass being benign or malignant often correlates with age; masses in postmenopausal women show a slightly higher chance of malignancy. Most masses, especially in reproductive-aged women, are benign and related to normal hormonal cycles or common conditions.
Benign Conditions
Ovarian cysts are the most frequent type of pelvic masses, forming as fluid-filled sacs on or inside the ovary. Many are follicular cysts, which are functional and typically resolve without intervention.
Other benign masses include dermoid cysts, which are complex growths formed from reproductive cells that can contain various types of tissue. Uterine fibroids are non-cancerous growths composed of muscle tissue that develop within the walls of the uterus.
Fibroids are common in reproductive-aged individuals, ranging in size from microscopic to large enough to distort the uterus’s shape. Endometriosis can form a mass called an endometrioma, often referred to as a “chocolate cyst.” A mass can also be caused by an ectopic pregnancy, where a fertilized egg implants outside the main cavity of the uterus, most often in a fallopian tube.
Malignant Conditions
While less common, some pelvic masses are cancerous. Ovarian cancer is a primary concern, with the most common form being epithelial cancer, which originates from the cells covering the surface of the ovary. Malignant masses are often described on imaging as complex, meaning they may contain solid areas, multiple compartments, or thicker fluid, unlike the simple appearance of most benign cysts.
Cancers originating from the uterus (such as endometrial cancer) or the cervix may also present as a pelvic mass. Non-gynecologic cancers, such as those of the colon or rectum, can also be detected as growths within the pelvic space.
How Pelvic Masses Are Diagnosed
Diagnosis begins with a comprehensive medical history and a physical examination, including a pelvic exam where a provider may palpate the mass. For any woman of childbearing age, a pregnancy test is performed, as an enlarged pregnant uterus is a common cause of a perceived mass.
Imaging tests confirm the mass and evaluate its characteristics. Transvaginal ultrasound is typically the first and most effective tool, using sound waves to distinguish between a fluid-filled cyst and a solid tumor. Ultrasound provides information on the mass’s size, shape, and location, helping to classify it as simple or complex.
If ultrasound findings are inconclusive or if cancer is suspected, further detailed imaging may be ordered, such as a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI). These scans provide a broader view of the abdomen and pelvis, assessing the mass’s relationship to nearby organs and checking for signs of spread.
Blood tests are also utilized, notably the CA-125 tumor marker, which can be elevated in cases of ovarian cancer. However, CA-125 can also be raised by many benign conditions, including endometriosis, fibroids, and pelvic inflammatory disease. A definitive diagnosis often requires surgical removal of the mass, followed by a pathologist’s examination of the tissue.
Navigating Treatment Options
The management of a pelvic mass depends on its origin, whether it is benign or malignant, its size, and the severity of the symptoms. The patient’s age and desire to preserve fertility are also factors in the decision-making process. Treatment pathways fall into three categories: observation, medical management, or surgical intervention.
Watchful waiting, or observation, is the appropriate approach for most small, asymptomatic, and clearly benign masses, such as simple ovarian cysts. The mass is monitored over several weeks or months with serial ultrasounds to ensure it remains stable or shrinks, which often occurs with functional cysts.
Medical management involves using medications to address the underlying cause or control symptoms. This includes hormonal treatments, such as birth control pills, which can suppress the growth of certain masses like endometriomas or help manage fibroid symptoms.
Surgical intervention is recommended when a mass is large, causing significant symptoms, increasing in size, or when malignancy is suspected. For benign masses, minimally invasive procedures like laparoscopy (keyhole surgery) are often used to remove the mass while preserving the affected organ.
Examples include a cystectomy to remove an ovarian cyst or a myomectomy to remove a fibroid. If the mass is malignant, a more extensive surgery, known as a laparotomy (open surgery), may be required. This often involves removing the uterus, cervix, both ovaries, and fallopian tubes, along with sampling lymph nodes to determine the cancer stage. Following surgery, treatment frequently includes additional therapy, such as chemotherapy.